68 EGFR AND ONE-HOUR BIOPSY: BETTER PREDICTORS OF DECEASED KIDNEY TRANSPLANTS USING IN-SITU-COOLING DOUBLE-BALLOON CATHETERS SYSTEM

66

What is the optimal management of transitional cell carcinoma in a European renal transplant population?

Rogers A.G.1, Koo Ng J.2, Glendinning R.3, Rix D.A.1 1 Newcastle upon Tyne NHS Trust, Dept. of Urology, Newcastle, United Kingdom, 2 James Cook University Hospital, Dept. of Urology, Middlesbrough, United Kingdom, 3Sunderland Royal Hospital, Dept. of Urology, Sunderland, United Kingdom Introduction & Objectives: The incidence of malignancy is higher in patients with renal transplants compared to the general population. There is wide geographical variation in the types of malignancy and Transitional Cell Cancer (TCC) is uncommon in Europe. When it does occur it has been reported as being more aggressive than when observed in the general population. Therefore the optimal management and follow up for patients in this cohort remains unclear. Our aim was to characterise the management of TCC in our European renal transplant population and review the current literature. Materials & Methods: A retrospective review of renal transplant patients with a diagnosis of TCC was performed. Patients were identified by histology and transplant coding searches in one renal transplant centre in the UK, for the 15 year period 1995-2009. The outcomes and management were reviewed for patients who; i) developed de-novo TCC following transplantation and ii) had preexisting TCC who then had a subsequent renal transplant. A literature review was performed using Medline. Results: 1647 renal transplants were performed between 1995-2009. 12 patients with TCC were identified. There were 8 cases of de-novo transitional cell carcinoma following renal transplantation(0.48%). Bladder was the site in all 8 cases. 7 were superficial (pta/T1) and 6 were low grade. A patient with pT2 G3 disease underwent cystectomy and ileal conduit but died from metastases. Median time to development of TCC post transplant was 5 years. Mean age at transplantation was 55 years (range26-74) and mean follow up from transplantation is 11.5 years (range 5-18). In those with low grade superficial disease no progression has been observed and patients have been managed endoscopically. 4 patients had TCC prior to transplantation. Two patients had been treated with cystectomy and ileal conduit for pT2 G3 TCC. In one of those prophylactic bilateral nephro-ureterectomy prior to transplantation was also performed. One patient with superficial disease prior to transplantation developed progression whilst on immunosuppresion. There were no cases of upper tract TCC. Intravesical BCG and systemic chemotherapy were not used in our patients. There have been 21 case series/reports to date investigating TCC in renal transplant patients, totalling 129 patients. 78 cases(60%) are from China/Taiwan where there is a high incidence of upper tract and high grade muscle invasive TCC. Conclusions: To the best of our knowledge this is the largest European case series of renal transplant patients with TCC, however the numbers are small making clear conclusions difficult. The frequency of TCC is low, in keeping with previous studies. Contrary to prior studies, TCC following renal transplantation in this European population, was predominantly superficial, low grade, nonprogressive and confined to the bladder. The reasons for this are unclear and warrant further investigation

67

Acquired cystic kidney disease and renal cell carcinoma in end stage renal disease nephrectomy specimens

Campillo P.1, Musquera M.1, Peri Ll.1, Mallofre C.2, Alvarez-Vijande R.1, Alcaraz A.1 1 Clinic Hospital of Barcelona, Dept. of Urology, Barcelona, Spain, 2Clinic Hospital of Barcelona, Dept. of Pathology, Barcelona, Spain Introduction & Objectives: Acquired renal cystic disease (ARCD) is an entity that has been described in a higher percentage in patients with end-stage renal disease (ESRD). Its incidence is not well known but is directly related to long term dialysis treatment (40-90%). The prevalence of renal cell carcinoma (RCC) in patients with ESRD on dialysis ranges between 0.5-4.2%, which is 10-100 fold higher than in the general population. Our objective is to analyze the incidence of ARCD and renal cell carcinoma in the native kidney in a population of patients with ESRD in whom a nephrectomy was done previous orthotopic kidney transplantation. Materials & Methods: We retrospectively reviewed 69 native kidney nephrectomy pathology reports and medical records from patients undergoing orthotopic kidney transplant between October 1991 and August 2010. Patients with polycystic kidney disease as the primary renal disease were excluded from the analysis. Oncological follow-up was performed in renal neoplasm patients. Results: 69 orthotopic kidney transplant where performed during this period. Seven patients with primary cystic kidney disease where excluded from the analysis. The mean age of the 62 patients were 49 years (19-70). Most of them had ESRD caused by diabetes. The mean interval between hemodialysis (HD) and transplantation was 6.8 years. Twenty-three patients (37%) had cystic changes in the kidney consistent with ARCD, that was associated with hyperplasia in 8 cases (35%), and with renal mass in 5 cases: 2 renal adenomas (9%) and 3 renal cell carcinomas (13%) (table 1). The overall incidence of neoplasms in the population studied was 4,8%. The mean hemodialysis duration in patients with and without ARCD was 9 years and 3,2 years, respectively.

Eur Urol Suppl 2011;10(2):48

Age

Tumor size

Stage

Subtype

ARCD

Time on dialysis

Follow up

33 y

1.7 cm

pT1a

Cystic

Yes

8.9 y

12.2 y

61 y

1.5 cm

pT1a

Papillary

Yes

3.3 y

2.4 y

46 y

0.5 cm

pT1a

Papillary

Yes

15.5 y

Post-op death

Conclusions: Acquired renal cystic disease and renal cell carcinoma are common in patients with end-stage renal disease on dialysis. The prevalence of renal cell carcinoma is higher than in general unselected population, with histopathological distribution change, being mainly papillary subtype.

68

EGFR and one-hour biopsy: Better predictors of deceased kidney transplants using in-situ-cooling double-balloon catheters system

Mizutani K.1, Hattori R.1, Kinukawa T.2, Kamihira O.3, Gotoh M.1 1 Nagoya University Graduate School of Medicine, Dept. of Urology, Nagoya, Japan, 2Chukyo Hospital, Dept. of Urology, Nagoya, Japan, 3Komaki Shimin Hospital, Dept. of Urology, Komaki, Japan Introduction & Objectives: The worldwide shortage of deceased donor kidneys for transplantation has become a serious issue in the past decade and marginal donor kidneys have been studied. However, both the availability and feasibility of kidneys from deceased donors is still unclear. Some kidney donor candidates have been rejected because of increased creatinine(Cr) levels prior to death, while some transplants have had good renal function in spite of the high Cr levels of the donors. In order to reduce the discarded donor kidney rate, we performed specially designed in-situ cooling system. The aim of the present study was to estimate availability of deceased donor kidney with using our in-situ-cooling system, analyze donor one-hour biopsy, and find better evaluation method to estimate donor kidney function rather than using donor Cr. Materials & Methods: We studied 129 deceased renal transplant recipients who received kidneys from non-heart-beating donors beginning in 1984. Calcineurin Inhibitors (Cyclosporine or Tacrolimus) were given to all transplants. Those donors were in Maastricht Donor Categories III and IV and, in order to minimize warm ischemic kidney damage, we performed in situ cooling with specially designed double-balloon catheters. One-hour biopsies were analyzed with Remuzzi’s evaluation system.　 Results: The average donor Cr levels at admission were 0.3 - 2.1mg/dl (Average 1.0) and those level before death were 0.3 - 15.9 (Average 2.7). The average recipient Cr levels at discharge were 0.3 - 5.3 (Average 1.8). Although the average donor Cr levels before death were high levels, transplanted kidneys had good function with using our catheter system. To define the best measure of kidney function after transplant, recipients were classified according to estimated donor glomerular filtration rate (eGFR) at discharge: <25 ml/min/1.73 for the poor function group (n=32) and >25, the good function group (n=95). There was no statistically significant difference in Cr levels of donor (at admission and before death) between those groups. And both groups had no statistically significant difference in ischemic time of organ procurements. However, the good function group had higher eGFR levels at admission to the hospitals than the poor function group (p=0.005), although there was no statistically significant difference in eGFR levels before death. Pathologically, the good function group had less glomerular global sclerosis, tubular atrophy, and arterial/arteriolar narrowing than the poor function group in one-hour biopsies.(p=0.0000001, 0.003, 0.0002) . Histological scores of interstitional fibrosis was not associated with kidney function. Conclusions: In conclusion, our kidney transplants had excellent renal function with double balloon catheter system. Although donor Cr levels were not a useful measurement for our analysis, eGFR was and should be used for donor evaluation.

69

Do intra-operative hemodynamic factors of the recipient influence renal graft function?

Campos L.C.N., Parada B.A.C., Furriel F.T.G., Castelo D.J.S., Moreira P.N.S.B., Mota A.J.F. Coimbra University Hospital, Dept. of Urology, Coimbra, Portugal Introduction & Objectives: Renal transplantation is now recognized as the treatment of choice for patients with end-stage renal disease. Postoperative graft function is not exclusively determined by donor and graft characteristics. The main purpose is to assess the importance of intra-operative management of hemodynamic factors of the recipient and its influence on immediate and delayed graft function. Materials & Methods: Retrospective study of 1966 consecutive renal transplants performed in our Department between June 1980 and December 2009. We analyzed several per-operative hemodynamic factors of the patient: central venous pressure (CVP), mean arterial pressure (MAP), volume of fluids, fresh frozen plasma (FFP), albumin and whole blood transfusions; and its influence on renal graft function parameters (immediate dieresis, serum creatinine levels, acute and